Practical considerations for the implementation of daxibotulinumtoxinA for injection for management of cervical dystonia

DaxibotulinumtoxinA (DAXI) for injection is approved for treatment of adults with cervical dystonia (CD) and is the first botulinum neurotoxin (BoNT) to be formulated with a novel, custom-engineered peptide.

To provide practical considerations for incorporating DAXI into clinical practice based on real-world experience from early adopters.

The perspectives and practical considerations were informed by a panel of physicians with extensive experience treating CD with BoNT who participated in a DAXI early-experience program. Considerations were drafted based on individual physician questionnaire responses and finalized through individual and group discussions. All authors reviewed and approved the final practical considerations.

Patients experiencing symptom re-emergence before retreatment with their current BoNT or seeking longer-lasting symptom relief are the primary candidates for DAXI. For patients switching from other BoNTs, the initial DAXI dose can be proportional to their prior onabotulinumtoxinA-equivalent dose, recognizing that units of different BoNTs are not interchangeable, with titration to an appropriate maintenance dose over 2-3 cycles. The low rate of dysphagia and muscle weakness adverse events provides a foundation for safe implementation and dose titration.

Early real-world experience suggests that DAXI can be readily implemented in practice. Optimal individual dosing is established in 2-3 treatments, and retreatments can be timed to address symptom re-emergence. Consistent with phase 3 clinical trials, DAXI demonstrates a long duration of action and wide safety margin, offering long-lasting symptom relief and potentially greater flexibility in patients who experience early symptom re-emergence within a standard 12-week retreatment interval.